Laserfiche WebLink
i"y <br />APPLICATI�.N FOR CONSTRUCI �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />rl DEMOLITION fl COMBINATION �I BUILDING fl MECHANICAL �� PLUMBING fl SIGN <br />PROJECT ADDRESS <br />9�odZ [vev'yv��-C.� �/-�/� <br />OWNEq MAILAOORESS <br />� ��or� '4n rZ�s <br />TEN�NT 1 p.YLA�ORE55 <br />s �rze s �i6oZ �v, <br />ARCIIITECTORDESIGNER MPILA��RE55 <br />�?�-w� m1�CTtYIS �� <br />GENEPALGONTRACTOR MaIL^A^0�PE55 <br />Mfr`� <br />CITV ZIP PNORE <br />CITY 71P`� PIICNE <br />��P� '✓Ay �v���r ,�F 53a�Y 3S-S-f�66 <br />Cltt 7�p PNONE <br />, 3`f�sr s�o�� SY7--u'�s �km� <br />CIIY Z�p n P1104[ $IATE LIC[NSE � <br />MECNANICAI CONTR�CTOl1 MAIL AODRESS CITV ZIP PIIONE STATL UCENSE � <br />PLUl.IBING CONTRACTOR MAIL �ODPESS CITY ZIP PHONE STATE LICEHSE � <br />CONTRACT Pf1ICE <br />i <br />OESCRIBE WORN i <br />PROPOSED USE <br />�or <br />OUAR�OTAGE INVOLVEDO � � C <br />iT N <br />i' �f'y2r' -r iSro� <br />,.-� -r N �ql.}- cl„ <br />LDING <br />' PROPER7Y �SHOWN 9ELOW OR ATfACH T <br />BLOCI( OF <br />CONSTRUCTIONLORNLENDER.FO�RESS.TELEPHONENUMBER <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KIl"CHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.I <br />SUB TOTAL 3 <br />PERMIT S <br />TOTALFEE 3 <br />FGR OFFICE USE ONLY: <br />FRONTSET[1ACN REAf15F.T�ALN <br />USEZONE IAipREA <br />HEIGNiLIM1TATION NO.OfOWELLING <br />UNI7S <br />OFf,ONST <br />pY <br />FEE <br />SIDE SETB/LK <br />V4CANi SITE <br />f1YE5 f' NO <br />HEATING SYSTEM: 1�GAS fl ELECTRIC fl <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A'.� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE ()F <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIE7 HEREIN G�R <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF .1NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TH[ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION �S MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X ,J�l/ � . ��/Z-�� <br />SIGNRTUR OATE <br />CITV BlI5ME55 LICENFE BO. <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C — A/HNDLG UNRS — H.P. `_ <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br />HEAT PUMP � <br />— B.T.U. M <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL Fli;EPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT 5 <br />PL�NCIIE� UM�/ I FEF I RECEIPiNO. <br />v <br />ow�oiNc <br />SIZE OF BLDGRI <br />PLUMpING <br />Br15EMENT MECN4NICAL <br />I1vES fl NO <br />AppIIION�I. PLAN CHF.CN <br />OTIIEF <br />STATE Ol11LDINC. SUf1C11ARGE <br />CI7Y OF EVERETT runi ic wonKs <br />LOCAL SALES <br />? � TAX CODE IS 3105 TOTAL <br />